Open Access Highly Accessed Research article

Hand disinfection in a neonatal intensive care unit: continuous electronic monitoring over a one-year period

Onno K Helder1*, Johannes B van Goudoever23, Wim C J Hop4, Johannes Brug5 and René F Kornelisse1

Author affiliations

1 Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children’s Hospital, Erasmus University Medical Center, PO Box 2060, room SK-1286, Rotterdam, 3000 CB, The Netherlands

2 Department of Pediatrics, VU University Medical Center Amsterdam, Amsterdam, The Netherlands

3 Department of Pediatrics, Emma Children’s Hospital, AMC Amsterdam, Amsterdam, The Netherlands

4 Department of Biostatistics, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands

5 EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands

For all author emails, please log on.

Citation and License

BMC Infectious Diseases 2012, 12:248  doi:10.1186/1471-2334-12-248

Published: 8 October 2012



Good hand hygiene compliance is essential to prevent nosocomial infections in healthcare settings. Direct observation of hand hygiene compliance is the gold standard but is time consuming. An electronic dispenser with built-in wireless recording equipment allows continuous monitoring of its usage. The purpose of this study was to monitor the use of alcohol-based hand rub dispensers with a built-in electronic counter in a neonatal intensive care unit (NICU) setting and to determine compliance with hand hygiene protocols by direct observation.


A one-year observational study was conducted at a 27 bed level III NICU at a university hospital. All healthcare workers employed at the NICU participated in the study. The use of bedside dispensers was continuously monitored and compliance with hand hygiene was determined by random direct observations.


A total of 258,436 hand disinfection events were recorded; i.e. a median (interquartile range) of 697 (559–840) per day. The median (interquartile range) number of hand disinfection events performed per healthcare worker during the day, evening, and night shifts was 13.5 (10.8 - 16.7), 19.8 (16.3 - 24.1), and 16.6 (14.2 - 19.3), respectively. In 65.8% of the 1,168 observations of patient contacts requiring hand hygiene, healthcare workers fully complied with the protocol.


We conclude that the electronic devices provide useful information on frequency, time, and location of its use, and also reveal trends in hand disinfection events over time. Direct observations offer essential data on compliance with the hand hygiene protocol. In future research, data generated by the electronic devices can be supplementary used to evaluate the effectiveness of hand hygiene promotion campaigns.